[Diagnostic validity of the isolated measurement of blood pressure in the community pharmacy. Optimum cut-off points]. / Validez de la medida aislada de la presión arterial en farmacia comunitaria. Puntos de corte óptimos.

INTRODUCTION AND OBJECTIVES: The aim of this study is to determine the diagnostic validity of blood pressure measurement in the community pharmacy (CPBP), and to set the cut-off points in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in order to maximise the aforementioned validity, using 24 hour ambulatory blood pressure monitoring (ABPM) as the reference method. MATERIAL AND METHODS: A cross-sectional study with consecutive selection of patient users of the community pharmacy in Andalusia. The CPBP was measured, followed by 24-hour ABPM, which assessed the diagnostic validity of the CPBP. The AUC of the ROC curve was also calculated for SBP and DBP, along with the positive and negative predictive values, for different prevalences and the variation of sensitivity and specificity for the different cut-off points for SBP/DBP. RESULTS: A total of 167 community pharmacy participated with 1,170 patients, of which 1,110 were valid. The CPBP showed a sensitivity of 60.41% (95% CI: 56.40-64.29), and a specificity of the 79.77% (95% CI: 76.12-82.99), a positive predictive values of 76.96% (95% CI: 72.89-80.57), and a negative predictive values of 64.31% (95% CI: 60.55%-67.90%). By using the ROC curve method, the optimal cut-off points are 134/81mm Hg, the point where the sensitivity and specificity and are balanced and the Youden index is maximised. CONCLUSIONS: The sensitivity is relatively low. To improve it tends to lower the cut-off points of SBP and DBP. The calculated optimum is 134/81mm Hg. This provides data on the desirability to review the current cut-off points (140/90), as proposed by the ACC/AHA 2017.

Health-related quality of life in patients with obstructive sleep apnea: effects of long-term positive airway pressure treatment.

The aim of the present study was to determine the effect of middle and long-term positive airway pressure (CPAP) treatment on the health-related quality of life in patients with obstructive sleep apnea. We prospectively studied two groups of patients with this disease; a group of 42 patients (33 men and 9 women) with a mean age of 55.2 +/- 7.4 years and a body mass index of 33.5 +/- 6.4 kg/m2 treated with CPAP for 6-months, and another group of 42 patients (34 men and 8 women) with a mean age of 54.4 +/- 10.5 years and a body mass index of 33.2 +/- 4.0 kg/m2 treated with CPAP for 18-months. The health related quality of life was assessed by administering a Medical Outcomes Study Short Form-36 (SF-36) questionnaire before and after CPAP therapy. Patients treated with CPAP for 6 months only improved significantly in the vitality dimension and this change was clinically relevant (standard error of the measurement = 1.43 SEmeas). In contrast, those treated with CPAP for a long period (18-month) showed statistically significant improvement at post-treatment in five SF-36 dimensions: physical functioning (P < 0.001), role physical (P < 0.01), social functioning (P < 0.01), vitality (P < 0.001), and general health perception (P < 0.001). In four of these dimensions the improvement was clinically relevant: role physical (1.16 SEmeas), social functioning (1.35 SEmeas), vitality (1.35 SEmeas), and general health perception (2.05 SEmeas). Using two different global rating of change (independent measures or anchors), the minimal change important difference for patients treated with CPAP for 6 months ranged from 20.7 to 24.2 points on the vitality dimension; and for patients with CPAP for 18-months it ranged from 2.5 to 7.5 points on the physical role, 5.5-6.6 points on social functioning, 7.5-8.7 on vitality, and 13.5-15.5 on general health perception dimension. We conclude that health-related quality of life of obstructive sleep apnea patients improves with long term CPAP treatment and these changes are clinically relevant in several health dimensions.

Factors influencing the fracture of nickel-titanium rotary instruments.

AIM: To evaluate the effect of rotational speed and the angle and radius of curvature of root canals on the fracture of two types of nickel-titanium rotary instruments: K3 and ProTaper. METHODOLOGY: A total of 240 root canals of extracted human maxillary and mandibular molars were divided into two groups of 120, according to the angle of the canal curvature (group A: <30 degrees, group B: >30 degrees). Each group was then divided into two subgroups of 60 canals in order to perform instrumentation using K3 and ProTaper rotary instruments at three different rotational speeds: 150, 250 and 350 r.p.m. (20 canals at each rotational speed). Each instrument was used a maximum of 20 times and at one rotational speed only. The angle and radius of canal curvature were measured in the only group in which fractures actually took place (group B). RESULTS: There were a total of 22 instrument fractures; all of these occurred in canals with curves >30 degree. In a multivariate analysis, it was demonstrated that the files used at a rotational speed of 350 r.p.m. were more likely to fracture than those used at 250 r.p.m. (OR: 1113.88; 95% CI: 2.36-526420.05) and than those used at 150 r.p.m. (OR: 13531.33; 95% CI: 5.37-34120254.00). A decrease in the angle of curvature of the canal also significantly reduced the likelihood of fracture (OR: 0.2083; 95% CI: 0.068-0.6502). These relationships remained significant after being adjusted for the potential interactions between the remaining variables. No significant differences were found between the files or the radii of the canals. CONCLUSIONS: Instrument fracture was associated with rotational speed and the angle of curvature of the canal.